Membership Application

ASECU Membership Application

Membership is available to anyone who lives, works, worships or attends school in Mahoning, Trumbull or Columbiana county in Ohio.

* Required Fields

Primary Member

First Name:

Last Name:

Social Security Number or TIN:

Drivers License #:

Upload photo of Primary Member driver's license or state ID:

Street Address:

Own or Rent Your Home:

City:

State:

Zip:

Date of Birth:

/ /

Email Address:

Home Phone:

Cell Phone:

Work Phone:

Employer:

Password:

Account Type:

How Did You Hear About Us?

Joint owners will be added to all current and future share accounts opened under the same membership account number, unless otherwise designated in writing and agreed to by the Credit Union. The terms and conditions of credit union membership and all accounts apply to each account owner jointly and severally. All joint account holders have rights of survivorship which means that when one owner dies, all sums in the account will pass to the surviving owner(s). All account owners agree that only one (1) periodic statement shall be provided for each account number, regardless whether the statement contains information, accounts or sub-accounts for which all parties may not have an ownership interest.

Joint Owner(s)

Joint #1

Joint Owner Name:

Joint Owner Social Security Number or TIN:

Joint Owner Date of Birth:

/ /

Joint Owner Driver's License #:

Upload photo of Joint Owner driver's license or state ID:

Joint Owner Email Address:

Joint Owner Street Address:

Joint Owner City:

Joint Owner State:

Joint Owner Zip:

Joint Owner Primary Phone:

Joint #2

Joint Owner # 2 Name:

Joint Owner # 2 Social Security Number or TIN:

Joint Owner # 2 Driver's License #:

Joint Owner # 2 Date of Birth:

/ /

Joint Owner # 2 Email Address:

Joint Owner # 2 Street Address:

Joint Owner # 2 City:

Joint Owner # 2 State:

Joint Owner # 2 Zip:

Joint Owner # 2 Primary Phone:

Designation of Primary Beneficiaries (the total percentage designated must equal 100%)

Beneficiary #1

Beneficiary #1 Name:

Beneficiary #1 Address:

Beneficiary #1 Date of Birth:

/ /

Beneficiary #1 Relationship:

Beneficiary #1 Taxpayer ID:

Beneficiary #1 Percent Designated:

Beneficiary #2

Beneficiary #2 Name:

Beneficiary #2 Address:

Beneficiary #2 Date of Birth:

/ /

Beneficiary #2 Relationship:

Beneficiary #2 Taxpayer ID:

Beneficiary #2 Percent Designated:

Beneficiary #3

Beneficiary #3 Name:

Beneficiary #3 Address:

Beneficiary #3 Date of Birth:

/ /

Beneficiary #3 Relationship:

Beneficiary #3 Taxpayer ID:

Beneficiary #3 Percent Designated:

Beneficiary #4

Beneficiary #4 Name:

Beneficiary #4 Address:

Beneficiary #4 Date of Birth:

/ /

Beneficiary #4 Relationship:

Beneficiary #4 Taxpayer ID:

Beneficiary #4 Percent Designated:

Designation of Contingent Beneficiaries (the total percentage designated from each primary beneficiary must equal 100%)

The following Contingent Beneficiary(ies) becomes effective upon the death of the Primary Beneficiary.

SELECT ONLY ONE:

Contingent A Name:

Contingent A Address:

Contingent A Date of Birth:

/ /

Contingent A Relationship:

Contingent A Taxpayer ID:

Contingent A Percent Designated:

SELECT ONE:

Contingent B Name:

Contingent B Address:

Contingent B Date of Birth:

/ /

Contingent B Relationship:

Contingent B Taxpayer ID:

Other Contingent Percent Designated:

SELECT:

Contingent C Name:

Contingent C Address:

Contingent C Date of Birth:

/ /

Contingent C Relationship:

Contingent C Taxpayer ID:

Contingent C Percent Designated:

SELECTION:

Contingent D Name:

Contingent D Address:

Contingent D Date of Birth:

/ /

Contingent D Relationship:

Contingent D Taxpayer ID:

Contingent D Percent Designed:

Certification of Membership

By signing below, I apply for membership in, and agree to abide by the policies, procedures, rules and bylaws, plus any amendments or changes thereof, in the Associated School Employees Credit Union (herein “ASECU,” or “Credit Union”). I agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Savings Disclosure, Schedule of Fees, Funds Availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein, for any account I have with the Credit Union now or in the future and agree that ASECU may change those terms, conditions and schedules from time to time without notice. I certify that I am within the field of membership of this Credit Union, and the information provided on this application is true and correct. I authorize the Credit Union to verify my identifying information, account and collection history, and current account standing with consumer reporting agencies at the time of application and with the addition of products or services in the future; and further allow the Credit Union to report the same to such agencies.

IMPORTANT: Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means to you: when you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents. Transactions to or from any account may be limited until the verification of identity for all account signers is completed. All account owners must sign below and submit a copy of a valid driver’s license or other acceptable government issued identification.

Certification as to Taxpayer Identification Number and Backup Withholding

Instruction to signer: If you have been notified by the Internal Revenue Service (IRS) that you are subject to backup withholding due to payee underreporting and you have not received a notice from the IRS that the backup withholding has terminated, you must strike out the language in clause 2 of the following certification.

By signing here I certify, under penalties of perjury, (1) that the number on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and (2) I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and (3) I am a U.S. person (including a U.S. resident alien).

THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY PROVISIONS OF THIS DOCUMENT OTHER THAN THE CERIFICATIONS REQUIRED TO AVOID BACKUP WITHHOLDING

Electronic Signature Agreement: By affixing your name below, you are signing this document electronically and agree your electronic signature (hereafter referred to as "E-Signature") is the legal equivalent of your manual signature for this document. By signing below, you consent to be legally bound by this membership certification, E-Signature agreement and ASECU’s terms and conditions.

You agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and ASECU. You represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by this membership certification, E-Signature agreement and ASECU’s terms and conditions. You also understand and agree that your E-Signature executed in conjunction with the electronic submission of this application will be legally binding and such transaction will be considered authorized by you.

Signature:

Date:

/ /

Signature #2:

Signature #2 Date:

/ /

Signature #3:

Signature #3 Date:

/ /

Signature #4:

Signature #4 Date:

/ /

Security Code:

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